Quote of the Day

Democrats are looking ahead with hope that the anger in their party boils over so they can focus on hammering Republicans over health care. Next month, Republicans will give Democrats a vote on extending the enhanced ACA subsidies. It will almost certainly fail, and Republicans are preparing an alternative plan they can put on the floor to vote for instead. Nevertheless, it will give Democrats another opportunity to go on offense.

Sen. Brian Schatz (D-Hawaii) said while it’s “definitely a disappointment” the shutdown didn’t end with the outcome Democrats preferred, people should be directing their anger at those imposing higher health care costs on Americans.

Igor Bobic, Jennifer Bendery, and Arthur Delaney
November 11, 2025
Why Democrats Caved In The Shutdown Fight | HuffPost Latest News

What I don’t see discussed in the media in plain language is the consequences of these higher premiums. Except for U.S. New & World Report, the wording is all, at best, very circumspect:

5 Consequences If ACA Premium Subsidies End in 2026 | AJMC

The return of the subsidy cliff would likely lead to “coverage churn,” where individuals cycle in and out of insurance due to fluctuating income. This instability not only undermines continuity of care but also disrupts the broader insurance market by reducing the number of healthy, continuously insured individuals.

What expiring ACA subsidies could mean for consumers and the economy | Mizuho Insights

In the absence of subsidies, the U.S. healthcare system will confront lower volumes, tighter margins, and renewed financial pressure across the board. For a sector already navigating demographic shifts, labor shortages, and cost inflation, the withdrawal of federal support could prove a defining headwind in the years ahead.

What the End of Obamacare Subsidies Could Mean for Your Health Coverage | TIME

Insurers across the market—not just those relying on ACA subsidies—are bracing for the effects of the expiration, as volatility is expected.

The shutdown is about to end. Will millions lose their health insurance?

Without the pandemic-era subsidies, ACA health insurers could face the prospect of serving a larger share of high-cost enrollees, Corlette said.

“We could be in for a stretch where insurance companies have to raise their premiums again to reflect a smaller and sicker market,” Corlette said. “So 2027 premiums are likely to be even higher, and some insurance companies may decide this is not a market they want to continue being in.”

Hospitals Face a ‘Slow Train Wreck’ if ACA Subsidies End, Expert Warns | Health Care | U.S. News

Could the loss of these subsidies destabilize insurance markets, and if so, what kind of consequences could we see for patients and for providers?

We already know that insurance companies are bracing for a market that is much smaller, has fewer enrollees but is also much sicker than it has been.

That’s because insurance companies are assuming that the people most likely to be deterred by a higher premium are folks who are relatively young and healthy. What insurers really need is what they call a balanced risk pool, where there’s essentially a balance between healthy and sick people, with healthier people subsidizing sicker folks. Then the healthy people drop out, which means that the insurance companies have a smaller group of more expensive people to cover and then they raise their premiums.

Some of them may find the market less attractive because they worry they can’t fully recoup their costs. So we could see over time, not only rising premiums in this market but also fewer insurance companies participating.

Let me translate this for you. With the subsidies ending there is a high risk of a death spiral in the health insurance industry. As premiums rise, healthier enrollees are likely to drop coverage, leaving insurers with a sicker, costlier pool. This forces insurers to raise rates further, compounding “instability.”

Copilot supplied:

Bottom Line

The end of ACA subsidies would mean higher premiums, fewer enrollees, and greater instability for insurers, while threatening the ACA’s long-term viability. Unless Congress extends or replaces subsidies, the ACA could face a slow-motion collapse driven by adverse selection and affordability crises.

The insurance companies will have to revert to some of the previous practices which protected them against this sort of death spiral insurance premium situation. They will need to be able to refuse insurance to people with preexisting conditions. While unpopular, they may revert to having lifetime and annual limits which were banned by Obama Care.

As near as I can tell, the U.S. Constitution does not give the U.S. Government the power to provide health insurance. Of course, during the Obama administration SCOTUS disagreed with my reading of the U.S. Constitution.

My take on this is that the money has to come from some place. The subsidies are paid by taxes. By cycling the money through the tax process, then back to insurance companies, then to healthcare providers a considerable amount of “friction” has been introduced, and the total cost of health care has been increased. This is a waste of money.

Free markets are best because they reduce “friction” and the competition results in innovation.

Let ACA fail. Let people evaluate their own risks and be responsible for their own health care. Let insurance companies tailor their coverage for the markets and how they decide to define them. Let private charity groups vet and pay for deserving people unable to afford insurance or pay out of pocket. Let the people who chose to abuse their bodies with consumption of alcohol, tobacco, other recreational drugs, and other risky behaviors pay the price for their stupidity.

Prepare appropriately for the transitions.